Advocating for protection, value and investment in nursing - ICN Annual Report 2021

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All rights, including translation into other languages, reserved. No part of this publication may be reproduced in print, by photostatic means or in any other manner, or stored in a retrieval system, or transmitted in any form, or sold without the express written permission of the International Council of Nurses. Short excerpts (under 300 words) may be reproduced without authorisation, on condition that the source is indicated. Copyright © 2022 by ICN International Council of Nurses, 3, place Jean-Marteau, 1201 Geneva, Switzerland ISBN: 978-92-95099-98-2 Photographic credits: Alberto Giuliani Columbia University School of Nursing International Council of Nurses Terri Hyde, CDC Martin Van Der Belen, ICRC Elisa Fourt, MSF Adrian Wressell, Heart of England NHS FT Marion van Ool Jayme Gershen, WHO Mandy O’Neill, WHO Oliver Moeckli, ICRC Kate HOLT, ICRC Florian Seriex, ICRC Sarah Velasco, ICRC Saara Mansikkamaki, ICRC Tyumen Regional Nurses Association Blink Media, Bart Verweij, 2020, WHO MSF Florian Seriex, ICRC Australian Primary Health Care Nurses Association



THE INTERNATIONAL COUNCIL OF NURSES The International Council of Nurses (ICN) ) is a federation of more than 130 national nurses associations (NNAs), representing the more than 27 million of nurses worldwide. Founded in 1899, ICN is the world’s first and widest reaching international organisation for health professionals. Operated by nurses and leading nurses internationally, ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce. Follow us on Twitter and Facebook.



TABLE OF CONTENTS MESSAGE FROM THE ICN PRESIDENT...............5 INTRODUCING ICN.................................................6

ICN Members & Specialist Affiliates..............................6 ICN Secretariat.....................................................................8 ICN Board of Directors 2017-2021 & 2021-2025.........10 ICN’s Mission, Pillars and Strategic Plan.................... 11 Council of National Nursing Association Representatives (CNR)..................................................... 11

ICN GOAL 1: GLOBAL IMPACT............................ 12

Global Health Policy......................................................... 12 The International Year of the Health and Care Worker................................................................... 13 World Health Organization............................................... 13 United Nations...................................................................... 16 International Labour Organisation................................17 World Health Professions Alliance.................................17 G7 and G20.............................................................................. 18 Nursing Now Groups........................................................... 18 Global Health Issues.........................................................19 COVID-19.................................................................................. 19 Non-communicable diseases..........................................20 Patient safety........................................................................ 21 Mental health........................................................................ 21 Climate change..................................................................... 21 Gender equity....................................................................... 22 International Nurses Day 2021.......................................23


ICN Global Nursing Leadership InstituteTM.................33 Leadership For ChangeTM.................................................33 ICN Certified Global Nurse Consultant........................35 Advanced Practice Nursing.............................................35 APN Publications.................................................................. 35 ICN Nurse Practitioner/Advanced Practice Nursing Network................................................. 35

ICN GOAL 4: INNOVATIVE GROWTH.................36

ICN Congress.......................................................................37 International Classification for Nursing Practice®............................................................................. 38 Media and Social Media.................................................. 38 BBC Partnership...................................................................38 Publications....................................................................... 38

FINANCIAL OVERVIEW 2021...............................39

ICN GOAL 2: MEMBERSHIP EMPOWERMENT...................................................24

Awards..................................................................................25 Nursing Students...............................................................27 Strengthening and Protecting the Nursing Workforce.....................................................27 Addressing nursing workforce challenges.................. 27 Education................................................................................ 27 Violence...................................................................................28 Vaccine equity.......................................................................28 Strengthening NNAs........................................................ 30 Organizational Development of National Nursing Associations (ODENNA).....................................30 ICN Code of Ethics for Nurses..........................................30 World Continuing Education Alliance...........................30 Advocacy and lobbying...................................................... 31 ICN Humanitarian Fund...................................................... 31

The Sustainable Development Goals (SDGs), adopted by the United Nations in 2014, contain 17 goals covering a broad range of sustainable development issues for the world. Nursing has a major role to play in relation to SDG 3: Ensure healthy lives and promote wellbeing for all ages. Nursing work frequently includes addressing many of the other SDGs and nurses understand the links between wider conditions and individual and population health. Nurses, as the primary providers of healthcare to all communities in all settings, are key to the achievement of the SDGs. ICN’s work overlaps with the SDGs in many ways, as indicated through the use of the SDG symbol throughout this report.



MESSAGE FROM THE ICN PRESIDENT It is always constructive to look back on the past year to celebrate our achievements and reflect on what areas need more work, how we can better achieve our mission, how we can better serve our members. We entered 2021 with renewed determination to continue to advocate for the nurses of the world who had undergone so much during the pandemic. Our priorities were clear. We would ensure that nurses and midwives were not forgotten. As vaccines began to be administered, we would ensure that nurses and other healthcare workers were prioritised, that they were protected from violence, and that they were justly rewarded for their work. Throughout the year, we continued to keep nurses in the headlines of the most influential media, speaking to the BBC, CNN, Al Jazeera, and other media outlets about the issues nurses continue to face, such as vaccine equity, the nursing shortage, the effects of the pandemic on nursing education. And we didn’t just speak about the problems, we offered solutions: such as the Health Education Retraining Opportunities (HERO) Fund. We brought out weekly case studies from across the world to highlight nurses’ stories from the frontlines. We attended international policy making meetings, such as the World Health Assembly, to bring the nursing voice to the decision-making process. We continued to work closely with the World Health Organization to develop the Global Strategic Directions for Nursing and Midwifery, to bring expert speakers to lead debates and discussions at the ICN Congress, and to make interventions at the World Health Assembly and WHO Executive Board meetings. The ICN Congress, which we held virtually for the first time, was an incredible success! It brought nurses together to share best practices, find solutions to challenges and to focus on regional priorities. The Congress also enabled nurses from across the globe to hear from experts in a multitude of fields, including global political leaders and the heads of international organisations. The messages of support from celebrities also helped to raise our spirits!

We conducted surveys and published reports on the effects of the pandemic on the global nursing shortage, on the mass traumatisation of nurses and on nursing education. We produced Guidelines for Nurse Anesthetists and Nurse Prescribers, and a comprehensive assessment of the education and labour markets for nurses in the Eastern, Central and Southern African region. I would like to thank my predecessor, Annette Kennedy, under whose presidency the majority of this work was undertaken. With her watchword “Together”, she united the nurses of the world to raise our voices and influence global health policy. ICN is proud of our achievements and would like to thank our national nursing associations for their support in all our work. We look forward to strengthening our associations, and our health systems, working even more closely to lead the world to better, more accessible and more equitable, health.

Dr Pamela F. Cipriano President International Council of Nurses






ICN MEMBERS & SPECIALIST AFFILIATES ICN is a federation of over 130 national nurses associations (NNAs), representing the millions of nurses worldwide. We work directly with these member associations on issues of importance to the nursing profession. In addition, ICN grants affiliate status to a number of international specialist nursing organisations, which allows them certain privileges and benefits. Ensuring that NNAs, through their collective action at the global level, add value to their own countries and to the worldwide nursing community, ICN provides its members the platform and the means to achieve common goals through collaborative action, working together for the benefit of society, the advancement of the profession and the development of NNAs. ICN and its members work with a wide range of non-governmental organisations, governments, intergovernmental agencies, industry and key stakeholders to achieve maximum impact. • • • • • • • • • • •


Collegi d’Infermeres i Llevadores d’Andorra Associação Nacional de Enfermeiros de Angola Federación Argentina de Enfermería Aruba Nurses Association (ODEA) Australian College of Nursing Österreichischer Gesundheitsund Krankenpflegeverband (Austria) Nurses Association of the Commonwealth of the Bahamas Bahrain Nursing Society Bangladesh Nurses Association Barbados Nurses Association Fédération Nationale des Infirmières de Belgique (Belgium)

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Nurses Association of Belize Bermuda Nurses’ Association Colegio de Enfermeras de Bolivia Botswana Nurses Union Conselho Federal de Enfermagem (Brazil) Bulgarian Association of Health Professionals in Nursing Association Professionnelle des Infirmiers/ères du Burkina Faso Canadian Nurses Association Colegio de Enfermeras de Chile Chinese Nursing Association Asociación Nacional de Enfermeras de Colombia Ordre National des Infirmiers de la RDC (Democratic Republic of Congo) Cook Islands Nurses Association Colegio de Enfermeras de Costa Rica Croatian Nurses Association Sociedad Cubana de Enfermería Cyprus Nurses and Midwives Association Danish Nurses’ Organization Colegio Dominicano de Profesionales de Enfermeria (Dominican Republic) East Timor Nurses Association Federación Ecuatoriana de Enfermeras/os (Ecuador) Egyptian Nurses Syndicate Asociación Nacional de Enfermeras de El Salvador Eritrean Nurses Association Estonian Nurses Union Swaziland Nurses Association (Eswatini) Ethiopian Nurses Association Fiji Nursing Association Finnish Nurses Association Association Nationale Française des Infirmiers et Infirmières Diplômés et Etudiants (France) National Association of Gambia Nurses & Midwives

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DBfk Bundesverband (Germany) Ghana Registered Nurses Association Hellenic Nurses Association (Greece) Grenada Nurses Association INC. Asociación Guatemalteca de Enfermeras Profesionales Guyana Nurses Association Association Nationale des Infirmières Licenciées d’Haïti Colegio de Profesionales de Enfermería de Honduras College of Nursing Hong Kong Icelandic Nurses Association Indian Nursing Council Persatuan Parawat Nasional Indonesia Irish Nurses and Midwives Organisation Iranian Nursing Organization National Association of Nurses in Israel National Council of Nursing Associations of Italy Nurses Association of Jamaica Japanese Nursing Association Jordan Nurses and Midwives Council National Nurses Association of Kenya Korean Nurses Association Kuwait Nursing Association Order of Nurses in Lebanon Lesotho Nurses Association Liberia Nurses Association Lithuanian Nurses Association Association Nationale des Infirmiers & Infirmières Luxembourgeois Nurses Association of Macau National Organisation of Nurses and Midwives of Malawi Malaysian Nurses Association Malta Union of Midwives & Nurses Mauritius Nursing Association Colegio Nacional de Enfermeras, A.C. (Mexico)

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Federación Mexicana de Colegios de Enfermería (Mexico) Association Nationale des Infirmières de Monaco Mongolian Nurses Association National Association of Nurses and Midwives of Montenegro Association Marocaine des Sciences Infirmières et Techniques Sanitaires (Morocco) Asociação Nacional dos Enfermeiros de Mozambique Myanmar Nurses and Midwives Association Namibian Nurses Association Nursing Association of Nepal NU’ 91 – Netherlands New Zealand Nurses’ Organisation Asociación de Enfermeras Nicaragüenses National Association of Nigeria Nurses and Midwives North Macedonian Nurses and Midwives Association Norwegian Nurses Organisation Oman Nursing Association Pakistan Nurses Federation Palestinian Nursing and Midwifery Association Asociación Nacional de Enfermeras de Panamá Asociación Paraguaya de Enfermeras Colegio de enfermeros del Perú Philippine Nurses Association Polish Nurses Association Order of Nurses (Portugal) Qatari Nursing Association Romanian Nursing Association The Order of Nurses, Midwives and Medical Assistants in Romania Russian Nurses Association Rwanda Nurses and Midwives Association Samoa Registered Nurses Association, Inc



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Associaçäo Nacional dos Enfermeiros y parteiros de São Tomé e Príncipe Saudi Nurses Association (Saudi Arabia) Association Nationale des Infirmiers et Infirmières d’Etat du Sénégal Association of Health Workers of Serbia Nurses Association of the Republic of Seychelles Sierra Leone Nurses Association Singapore Nurses’ Association Nurses and Midwives Association of Slovenia Solomon Islands Nurses Association Somaliland Nursing and Midwifery Association Democratic Nursing Organization of South Africa South Sudan Nurses and Midwives Association Consejo General de Enfermería de España (Spain) Sri Lanka Nurses Association St. Lucia Nurses Association St. Vincent & The Grenadines Nurses Association Suriname Nurses Association Joint Virtual Swedish Nurse Organisation for International Work Association Suisse des Infirmières/Infirmiers (Switzerland) Taiwan Nurses Association Tanzania National Nurses’ Association Nurses Association of Thailand Association nationale des infirmiers/ères du Togo Tonga Nurses Association Trinidad & Tobago Registered Nurses Association Turkish Nurses Association Uganda Nurses & Midwives Union Emirates Nursing Association (UAE) Queen’s Nursing Institute (UK) American Nurses Association (USA) Colegio de Enfermeras del Uruguay Zambia Union of Nurses Organization Zimbabwe Nurses Association




Council of International Neonatal Nurses International Federation of Nurse Anesthetists International Federation of Perioperative Nurses International Nurses Society on Addictions International Society of Nurses in Cancer Care NANDA International Sigma Theta Tau International World Federation of Critical Care Nurses

ICN SECRETARIAT ICN headquarters in Geneva is home to a small but dedicated staff, under the leadership of Howard Catton, ICN’s Chief Executive Officer. In addition, ICN has several staff members working outside its Geneva Secretariat. In 2021, ICN appointed its inaugural Chief Nurse, Dr Michelle Acorn, to lead the development of ICN’s Nursing and Health Policy work, and the strategic development and delivery of ICN programmes and projects.






Finance & Administration




Programmes (PMO) Leadership projects


Policy Practice

Communication Internal & external Publications Sponsorship

Events Congress


ICN BOARD OF DIRECTORS 2017-2021 & 2021-2025


ICN is governed by a Board of Directors elected on the basis of ICN voting areas. The Board serves as the agent of the Council of National Nursing Association Representatives (CNR) and carries out policy consistent with the framework established by the CNR. The term of office for the 2017-2021 Board of Directors came to an end in 2021 when elections were held. The new President and Board for 2021-2025 took up their responsibilities on 4 November 2021.

Pamela Cipriano (American Nurses Association) President Lisa Little (Canadian Nurses Association) 1st Vice-President Karen Bjøro (Norwegian Nurses Organisation) 2nd Vice-President Lian-Hua Huang (Taiwan Nurses Association) 3rd Vice-President


Fatima Al Rifai (Emirates Nursing Association) Nora Eloisa Barahona De Peňate (National Nurses Association of El Salvador) Nanthaphan Chinlumprasert (Nurses Association of Thailand) José Luis Cobos Serrano (General Council of Nursing of Spain) Andre Gitembagara (Rwanda Nurses and Midwives Union) Yves Mengal (National Federation of Nurses of Belgium) Megumi Teshima (Japanese Nursing Association) Alisi Talatoka Vudiniabola (Fiji Nursing Association)


Annette Kennedy (Irish Nurses and Midwives Organisation) President Pamela Cipriano (American Nurses Association) 1st Vice-President Thembeka Gwagwa (DENOSA, South Africa) 2nd Vice-President Sung Rae Shin (Korean Nurses Association) 3rd Vice-President


Fatima Al Rifai (Emirates Nursing Association) Karen Bjøro (Norwegian Nurses Organisation) Erika Caballero (Colegio de Enfermeras de Chile) Lian-Hua Huang (Taiwan Nurses Association) Maria Eulália Juvé (Spanish General Council of Nursing) Roswitha Koch (Swiss Nurses Association) Ioannis Leontiou (Cyprus Nurses and Midwives Association) Lisa Little (Canadian Nurses Association) Brigita Skela Savic (Nurses and Midwives Association of Slovenia) Wu Ying (Chinese Nurses Association)







ICN’S MISSION, PILLARS AND STRATEGIC PLAN ICN’s mission is to represent nursing worldwide, advance the nursing profession, promote the wellbeing of nurses, and advocate for health in all policies. The Council has three pillars of work: socio-economic welfare, regulation and professional practice. ICN’s Strategic Plan 2019-2023 has four goals under which we will present our work: 1. 2. 3. 4.

COUNCIL OF NATIONAL NURSING ASSOCIATION REPRESENTATIVES (CNR) CNR is the governing body of ICN and sets policy at the macro level, including admission of members, election of the Board of Directors, amendments to the constitution, and setting of fees. The CNR was held virtually for the first time in October 2021 with representatives from 113 of ICN’s national nursing associations taking part. The meeting included the election of a new ICN President and Board for the term 2021-2025.

Global Impact Membership Empowerment Strategic Leadership Innovative Growth






and other healthcare workers can be found throughout this report as well as on our special report on ICN’s work on COVID-19 in 2021.

The World Health Organization (WHO) designated 2021 as the International Year of the Health and Care Worker under the theme Protect. Invest. Together. It highlights the urgent need to invest in health workers for shared dividends in health, jobs, economic opportunity and equity.


ICN, through the World Health Professions Alliance (WHPA), represented health professionals on WHO’s Steering Committee for The Year of the Health and Care Worker, chaired by WHO Director General Dr Tedros. The committee was responsible for driving the work for the year and particularly pushing for the world’s health and care workers to be prioritised for the COVID-19 vaccine in the first 100 days of 2021 and mobilizing commitments from Member States, international financing institutions, bilateral and philanthropic partners to protect and invest in health and care workers to accelerate the attainment of the SDGs and COVID-19 recovery.

ICN has been in official relations with WHO since its founding in 1948 and continues to work with the Organization on formal guideline development, policy development, advisory groups, and other activities. ICN has a particularly strong and close relationship with Dr Tedros Adhanom Ghebreyesus, WHO Director General (DG), who publicly recognises the importance of nursing and is committed to strengthening the profession, and with Elizabeth Iro, WHO’s Chief Nursing Officer (CNO). In 2021, ICN continued to strengthen its ties with WHO as the two organisations worked together to support and protect the nursing workforce fighting on the frontlines of the COVID-19 pandemic.

ICN has worked throughout the year to celebrate health and care workers and advocate for protection of and investment in the health workforce. In a January 2021 video, with colleagues from the WHPA, ICN President Annette Kennedy drew attention to the unacceptable number of infections and deaths of healthcare workers from COVID-19. In July, the ICN CEO, Howard Catton, participated in the virtual event organised by the WHO Health Workforce Department as part of a three-part webinar series. The campaign was also highlighted at the ICN Congress in a main session of the same name. More on ICN’s work to protect nurses

Representatives from WHO, including Dr Tedros took an active part in the ICN Congress in November including in a plenary session on global health challenges and nurses’ contribution to the global health agenda; main sessions on the International Year of the Health and Care Workers; the role of nurses in eliminating avoidable harm in healthcare; and the Global Strategic Directions for Nursing and Midwifery; as well as in symposiums on HIV-related stigma and discrimination in healthcare settings; the role of nurses in championing COVID-19 vaccination; and WHO work on Water, Sanitation and Hygiene.



Dr Tedros presented ICN President Annette Kennedy with the prestigious Director General’s Health Leaders Award for Outstanding Leadership in Global Health, in recognition of her life-long contribution to the nursing profession.

STRATEGIC DIRECTIONS FOR NURSING AND MIDWIFERY ICN took an active part in the development of the new WHO Global Strategic Directions for Nursing and Midwifery 2021-2025 (SDNM) which were launched in May 2021. In January, ICN hosted two webinars with WHO to discuss the SDNM. Around 400 nurse leaders from more than 80 countries shared their views on the actions they believed were important to include in the new SDNM within its four broad policy focus areas: jobs, pre-service education, leadership and practice. Several ICN Board members also made interventions on behalf of the region they represent. Information from the webinars was used by WHO to help shape the global nursing strategy over the coming four years. In May, the new SDNM were adopted at the 74th World Health Assembly. They addressed many of the issues that ICN had campaigned on over the past 18 months, including the ongoing global shortage of at least six million nurses; the need for investment in nursing jobs, education, leadership and practice, nurses’ safety in the face of the pandemic; and the vital importance of establishing Government-level Chief Nurses in every one of WHO’s Member States. ICN urged nations to implement its recommendations as soon as possible.

“This global strategy has never been more important, and we must implement it and take the actions forward. Unless governments and all stakeholders act now, the current situation, with nurses being overworked, underpaid and undervalued will continue, with potentially disastrous consequences for us all.” ANNETTE KENNEDY, ICN PRESIDENT, 2017-2021

In July, ICN hosted a webinar on how the SDNM will affect nurse education and workforce issues in East, Central and Southern Africa (ECSA). The webinar was intended to alert nurses to the ECSA Education and Labor Markets for Nurses report, jointly authored by ICN, the World Bank, the ECSA College of Nursing and Jhpiego, and its relevance to the SDNM. Cooperation and collaboration between nurses in different African countries and regions were highlighted as key components of a successful implementation of the


recommendations of the report, which focus on how to invest in nursing education, regulation, data and analysis, and the nursing labour market. The potential power of cooperation between QUAD leaders which include the government level nursing officer, the president of the NNA, a leading academic nurse and the nursing regulator – to make real changes and influence nursing and healthcare policy at the very highest level is promising. A main session on the SDNM was held at the ICN Congress led by Dr Jim Campbell, Director of the WHO Health Workforce Department, and Dr Carey McCarthy, WHO Nursing and Midwifery Technical Officer. ICN resources for leadership, jobs, service delivery and education were made available on the website of the WHO Nursing and Midwifery Global Community of Practice, a network for nurses and midwives around the world to come together to share initiatives and experiences, and to learn from experts from the different fields that have an impact on the global health agenda.

WHO EXECUTIVE BOARD AND WORLD HEALTH ASSEMBLY The annual WHO Executive Board (EB) meeting is held in January when Member States agree upon the agenda for the World Health Assembly (WHA) and the resolutions to be considered. The WHA, the decision-making body of WHO, is attended by health ministers and senior health officials from among the 194 WHO Member States, as well as representatives from civil society and other stakeholders. It focuses on a specific health agenda prepared by the EB. ICN represents the voice of nursing at these important meetings. The 148 th edition of the WHO EB was held from 18-26 January 2021. ICN made statements on: the Global action on patient safety; the Immunization Agenda 2030; COVID-19 response; and Mental health preparedness and response for the COVID-19 pandemic. The 74th WHA was held virtually 24-31 May 2021 with the theme Ending this pandemic, preventing the next: building together a healthier, safer and fairer world. ICN had a virtual delegation of over 50 nurse leaders from over 45 countries which included NNA member Presidents, alumni of the Global Nursing Leadership Institute, and government Chief Nursing Officers. ICN also had a student delegation made up of the ICN Nursing Student Steering Group Members. ICN delivered statements to the WHA on the Immunisation Agenda 2030; Health workforce; COVID-19 response; and the Social determinants of health. The Assembly adopted the new SDNM and discussed in detail WHO’s Human Resources Strategy and its COVID-19 work.

In his opening speech, Dr Tedros reported an estimate of 115,000 health and care worker deaths from COVID-19. The Independent Panel for Pandemic Preparedness and Response(IPPPR) presented its main report, Covid-19: Make it the Last Pandemic. ICN welcomed the report and the findings that showed that concrete action and ambitious financial commitments are required to help safeguard our underfunded, COVID-affected health systems. A full report on ICN interventions during the WHO Executive Board and 73rd World Health Assembly can be found here. A video summary of WHA74 can be found here and the full report can be found here. ICN also made a statement at the WHA 2nd Special Session, 29 November – 1 December, on consideration of the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response with a view towards the establishment of an intergovernmental process to draft and negotiate such a convention, agreement or other international instrument on pandemic preparedness and response, taking into account the report of the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies.





‘We have a moral obligation to protect all health and care workers, ensure their rights and provide them with decent work in a safe and enabling environment. This includes access to vaccines. As we recover and rebuild, investments in emergency preparedness and response must prioritise the education and employment of health and care workers, including nurses.” DR TEDROS ADHANOM GHEBREYESUS, DIRECTOR GENERAL, WHO

WHO REGIONAL COMMITTEE MEETINGS ICN took part in the 71st session of the WHO Regional Committee for Europe (13-25 September), making interventions on the Response to the COVID-19 pandemic: lessons learned to date from the WHO European Region, Reinventing primary healthcare in the post COVID-19 era and European Immunization Agenda 2030: Building better health for tomorrow; the 73rd session of the Regional Committee of WHO for the Americas (22 September), making a statement on the Strategy for building resilient health systems and post-COVID-19 pandemic recovery to sustain and protect public health gain; the 68 th session of the WHO Regional Committee for the Eastern Mediterranean (11 October), making an intervention on Accelerating health emergency preparedness and response – a plan of action; and the 72nd Session of the Regional Committee for the Western Pacific (25-29 October) with a statement on COVID-19.

UNITED NATIONS In June, ICN called on the United Nations to draft a Declaration on Pandemic Preparedness and set up a Global Health Threats Council to oversee global responses to international health emergencies. In a letter to United Nations Secretary General António Guterres, endorsing the findings of the Independent Panel for Pandemic Preparedness and Response, ICN urged Mr Guterres to spearhead a global response that will ensure that health and care workers are never forced to make similar sacrifices ever again.

“The confirmation that at least 115,000 healthcare workers have died from COVID-19 since the outbreak of the pandemic equates to more than 200 deaths per day. That is the equivalent of a daily airline disaster, yet no one is looking for the detailed data, the black box flight recorders that would help us to understand the causes, take action to protect healthcare workers and prevent further deaths. If this were happening in any other sector of our economies there would be an emergency response, an official inquiry, and commitments to put people’s safety first.” HOWARD CATTON, ICN CEO

In November, ICN took part in a meeting at the UN COP26 Climate Change Conference in Glasgow, speaking alongside colleagues from WHO and the Global Climate and Health Alliance (see page 22). United Nations High Commissioner for Human Rights, Dr Michelle Bachelet, was a plenary speaker at the ICN Congress in November, as was former UN Secretary General, Ban Ki-moon (see page 37 for more on the ICN Congress).



INTERNATIONAL LABOUR ORGANISATION On 27 April, ICN and the International Labour Organisation (ILO) hosted a webinar entitled COVID-19 Effect: Global Nursing & Health Worker Shortages and Changing Patterns of Employment as a Result of the Pandemic. This important discussion presented and explored the ICN concept of Health Education and Retraining Opportunity (HERO) funds which aim to increase the capacity of the education sector and support individuals who have lost their jobs to transition into the health workforce. It also discussed the ILO Nursing Personnel Convention (C149) which sets out education, employment and working conditions to attract and retain nurses. Mr Guy Ryder, Director General of the ILO, spoke at the ICN Congress in November, saying that investment in the nursing profession was important but needed “to go hand-in-hand with measures to combat a wider range of decent work deficits.”

“Building resilience into our health systems means investing in the training, pay and conditions of health and care workers. It means respecting their fundamental rights at work. The ILO is proud to stand with you, to strengthen and support the right of nurses to decent work.” GUY RYDER, DIRECTOR-GENERAL, ILO

WORLD HEALTH PROFESSIONS ALLIANCE The World Health Professions Alliance (WHPA) is a unique alliance of ICN, the International Pharmaceutical Federation, World Physiotherapy, the World Dental Federation and the World Medical Association. WHPA addresses global health issues, striving to help deliver cost effective, quality healthcare worldwide. Together, the partners of the WHPA include more than 600 national member organisations, making WHPA the key point of global access to healthcare professionals within the five disciplines. WHPA represented health professionals on WHO’s Steering Committee for The Year of the Health and Care Worker (see page 13). In March, the WHPA called for acceleration of vaccine equity for all frontline workers and invited health professionals to sign the WHO Vaccine Equity Declaration.



In May, ICN CEO Howard Catton participated in the WHPA Webinar entitled: COVID-19: an occupational disease? as part of the Stand up for Positive Practice Environments Campaign. The webinar discussed the importance of positive practice environments to safeguard the health and well-being of healthcare workers and help avoid the predicted shortfall. It focused on the need to ensure health professionals are duly supported, through the recognition of COVID-19 as an occupational disease, which can lead to reporting on deaths and infections, better risk assessment, standards set and compensation for those who die or are affected by COVID-19. In June, Howard Catton represented ICN at the roundtable, Joining forces towards improved vaccination access and coverage rates, with representatives from WHPA. The event was focused on the interprofessional and inter-agency collaboration in vaccination with other healthcare professions, public health agencies, external agencies and patient representative organisations to showcase the creation, development and impact of global advocacy and campaigns to improve vaccination coverage. Following the release of the report by the IPPPR (see page 15), the WHPA announced its support for the findings and concrete actions; asked policy makers, regulators, professional bodies, health facilities and communities to Stand Up for Positive Practice Environments, and called on all countries to classify and treat COVID-19 as an occupational disease. In December, the WHPA launched an exciting new initiative, Voices from the Field. This interview series gathers real-life examples from health professionals in the field and promotes health professionals so their work can be recognised and supported.




G7 AND G20 The Group of Seven (G7) and the Group of Twenty (G20) are informal governance clubs which hold annual Summits of Heads of State to discuss issues of global importance. Following the WHO announcement in May of the deaths of 115,000 health and care workers from COVID-19, ICN wrote to the G7 leaders ahead of their 47 th Summit, 11-13 June, to put nurses at the heart of a new pandemic treaty. ICN said the enormity of this tragic death toll among healthcare workers required swift and dramatic action from the leaders of the G7. In October, ICN called on the G20, which met in Rome on 30-31 October, to finally take strong action to protect vital nursing and healthcare staff from the ravages of the COVID-19 pandemic. The call followed an update by WHO on the number of deaths of healthcare workers from COVID-19 to 180,000 healthcare workers. ICN said it believed this to be a conservative estimate. With nurses still having to work unvaccinated and without proper personal protective equipment (PPE) in many parts of the world, ICN called for coordinated action to protect nurses.

NURSING NOW GROUPS Launched in 2018, Nursing Now – a global campaign to raise the status and profile of nursing – came to an end in June 2021. ICN carries on the legacy of this campaign through the Nursing Now Groups. Nursing Now continues to live on as the Nursing Now Challenge, a programme of the Burdett Trust for Nursing, which aims to create leadership development opportunities for 100,000 nurses and midwives in more than 150 countries by the end of 2022. In February, ICN held two webinars to discuss the future plans with Nursing Now Groups from around the world, building on the momentum and hard work that the groups as part of the Nursing Now campaign. ICN also took part in a number of Nursing Now webinars throughout the year. These included such topics as Influence and advocacy: shaping the future of nursing to launch the Nursing Now #NursesTogether campaign; Gender equality, decent work and nursing, examining why they are essential to promote nurse leadership and reach universal health coverage; Nurses on the move: the significance of nurse migration, exploring global trends in migration of nurses and looking at the experience of nurses who migrate and how it affects their ability to practice to the full extent of their knowledge and skills; and Nursing and midwifery in crisis.

On 24 May, Nursing Now, ICN and WHO held a Global Footprints event to mark the close of the three-year campaign. Starting in the Western Pacific, the event travelled around the world for a series of six regional sessions led by Nursing Now groups and Nightingale Challenge programmes as they reflected on experiences and lessons learned during the Nursing Now campaign. In June, ICN President Annette Kennedy led a discussion on ICN global leadership, global voice for nursing at the Nightingale Challenge for the RCSI Hospital Group in Ireland; and Howard Catton made an intervention at an event entitled Nurses at the forefront of change Challenging the status quo co-organised by the World Innovation Summit for Health Qatar, the Nursing Now Challenge and the BMJ on the occasion of the launch of the reports – Nursing’s pivotal role in global climate action, How the nursing profession should adapt for a digital future and Nurses for health equity. ICN Chief Nurse Michelle Acorn joined the Nursing Now Antioquia (Colombia) event in November, presenting live on Nursing Leadership. In December, ICN carried out a short survey of Nursing Now Groups about their most pressing policy priorities and what was happening in their countries on the WHO SDNM. ICN continues to value the contributions of the Nursing Now Groups around the world.

GLOBAL HEALTH ISSUES COVID-19 ICN’s work concerning the COVID-19 pandemic was so extensive that it cannot all be included this report. A separate report can be found here. This section will highlight only the main publications on COVID produced by ICN. At the start of 2021, ICN launched a new report on the mass trauma among nurses caused by the COVID-19 pandemic. It detailed the results of ICN’s survey of NNAs and included data on infections and deaths, stress and burnout and warned of a mass exodus from the profession. The survey results showed that overstretched staff were experiencing increasing psychological distress in the face of ever-increasing workloads, continued abuse and protests by anti-vaccinators. ICN warned that the pandemic risked damaging the nursing profession for generations to come unless governments take action now to address the COVID-19 Effect. ICN also published two fact sheets: one on COVID-19 infections and deaths among nurses and other healthcare workers, and the second on Stress and burnout in the nursing profession. In March 2021 – a year since WHO declared COVID-19 a global pandemic – ICN released an online publication on its work on COVID during 2020. Providing a monthby-month diary of this extraordinary year, the report exposed gender inequalities and lack of investment in nurses during this critical time. The 2021 report on ICN’s work on COVID can be found here. ICN also published a report and fact sheet on the global nursing shortage and nurse retention which showed that 90% of NNAs were somewhat or extremely concerned that heavy workloads and insufficient resourcing, burnout and


stress related to the pandemic response were resulting in increased numbers of nurses leaving the profession. Due to existing nursing shortages, the ageing of the nursing workforce and the growing COVID Effect, ICN estimated up to 13 million nurses would be needed to fill the global nurse shortage gap in the future. A further report and fact sheet on nursing education and the emerging nursing workforce in the COVID-19 pandemic was published in April. See the section on Vaccine Equity (see page 28) for more information on ICN’s work on the COVID-19 pandemic.

“The strain that nurses are under is unacceptable, and it is no surprise that so many are feeling the pressure and deciding that they can no longer continue in the jobs they love. When dedicated and experienced nurses call time on their profession, it is a clear indication that something is seriously wrong. Nurses cannot be expected to continue if they are overworked and under-valued. Our nurses have gone way beyond the call of duty this past year: governments must now repay their dedication and commitment with the support nurses need to carry on their vital work for the patients, families and communities that they serve so well.”

NON-COMMUNICABLE DISEASES Non-communicable diseases (NCDs) are the biggest killers on the planet, yet they are all amenable or even preventable if people make appropriate lifestyle changes. Nurses have a key role to play in helping people to adjust the way they live so that they can enjoy long, happy and healthy lives. ICN took part in several high-level international meetings on NCDs throughout 2021, including the WHO Strategic Roundtable, Building a NCDs-ready workforce, aimed at exploring key areas of competency-based capacity building to strengthen integrated NCD services; the World Heart Federation’s 6th Global Summit on Circulatory Health Time to Act on Obesity, where ICN addressed strengthening the health workforce to fight the nexus between CVD and obesity; the 9 th Conference of the Parties to the WHO Framework Convention on Tobacco Control where ICN delivered a video statement on the global progress in the implementation of the Framework. A main session exploring nursing’s role in tackling major health and social challenges, including NCDs, was held at the ICN Congress.






PATIENT SAFETY The delivery of safe, high-quality patient care is of utmost importance to nurses. As nursing care spans all areas of care delivery, nurses are well placed to prevent harm to patients and improve the quality and safety of healthcare delivered across all settings. As such, nurses should be central to the design and operation of all health providers’ patient safety systems and processes. On 18 March, the G20 Health and Development Partnership and RLDatix released a new report entitled, The Overlooked Pandemic – How to Transform Patient Safety and Save Healthcare Systems, which included a contribution from ICN President Annette Kennedy. As part of a virtual event for Patient Safety Awareness Week, Ms Kennedy spoke on a panel to launch the report. In August, ICN took part in the WHO Global Consultation Partners in Action: Engaging Stakeholders for Implementing the Global Patient Safety Action Plan 2021–2030 to discuss action for implementing the Global Patient Safety Action Plan, identify priority actions, and develop recommendations for the respective partners in action. In September, ICN joined the promotion of World Patient Safety Day by releasing a joint statement with the Council of International Neonatal Nurses, Inc., calling on all stakeholders to take sustainable actions that support the nursing workforce to deliver safe and respectful care, and to reduce avoidable harm to mothers and new-borns.

MENTAL HEALTH ICN is concerned about the lack of recognition of the health workforce role in the care, advocacy and leadership in dealing with mental health; and the absence of consumers and the community in the development of policies, strategies or legislation related to mental health. People-centred care and community engagement need to be front and centre in any future implementation plans.

commitment and accountability on this issue; a WHPA webinar on Safeguarding Health Professionals’ Mental Health; and the USAID, WHO, UNPF virtual forum entitled Giving Voice to the Silent Burden: Maternal Mental Health Technical Consultation. On World Mental Health Day, 8 October, ICN renewed the call to protect nurses’ mental health in the midst of the pandemic and highlighted the WHO Mental Health Atlas 2020 which provides an overview of mental health resources available around the world. The report shows that globally nurses represent 44% of the mental health workforce, though in some regions, such as the Western Pacific, they represent up to 68% of the workforce. In 2021, ICN conducted a Global Psychiatric-Mental Health Nursing Workforce Survey. The results will be used to inform the development of guidelines on Mental Health Nursing to be released in 2022.

CLIMATE CHANGE Climate and health action is a priority issue for ICN. Over the past several years, ICN has collaborated with global partners leading work in the area of climate change and health to increase engagement of the health sector and the nursing community in climate change mitigation and adaptation. On 6 September, ICN’s International Nursing Review joined over 200 leading health journals worldwide in demanding emergency action to keep average global temperature increases below 1.5°C, halt the destruction of nature and protect health. In October, ICN endorsed the WHO’s new COP26 Special Report on Climate Change and Health and called on the governments of the world to take immediate action to avert a climate crisis that will have devastating effects on the health of people everywhere. ICN signed an open letter to the 197 government leaders and national delegations warning that the climate crisis is the single biggest health threat facing humanity and calling on world leaders to deliver on climate action.

ICN took part in several webinars and meetings on the topic of mental health, including a webinar entitled COVID-19 and frontline workers, organised by the Global Self-Care Federation and Health Policy Watch in which ICN Chief Nurse Michelle Acorn spoke on mental health, the WHO EURO Mental Health Conference in Athens, where ICN CEO Howard Catton spoke on mental health and well-being of the health workforce, including the role of nursing associations in developing


“Whether it is the pandemic or the effects of climate change, people’s health is suffering severe consequences. Nurses are witnessing this unfolding global crisis and the suffering it is causing, and they are no longer willing to stay silent about it. The pandemic has created so much illness and death, but its effects will be dwarfed by those of climate change unless action is taken now.” HOWARD CATTON, ICN CEO

In November, ICN took part in a meeting at the UN COP26 Climate Change Conference in Glasgow and co-hosted an event as part of the COP26 WHO Health Pavilion programme with the Alliance of Nurses for Healthy Environments. Just prior to the release of the COP26 Declaration, ICN put out a statement warning that health workers would have to deal with the consequences if the declaration failed to deliver. ICN attended a WHO webinar on Climate Change for Health on 15 November which was held on the back of COP26 with the aim to stimulate interest, debate and discussion around nursing and midwifery engagement and commitment to the global Climate Change for Health agenda.

GENDER EQUITY Continuing gender inequalities have been exposed by the COVID-19 pandemic, ranging from unequal pay, lack of access to childcare, increased domestic abuse, inequality in workloads, and gender bias. In 2021, ICN drew attention to many of these issues. In 2021, ICN took part in several high-level discussion on gender and health. These included a webinar to celebrate the launch of the Women in Global Health’s 100+ Outstanding Women Nurse & Midwife list, which included ICN President, Annette Kennedy and a virtual side event at part of the 65th session of the Commission on the Status of Women, organised by Sigma Theta Tau International, entitled, Nurses take the lead: Creating gender responsive global health. ICN issued a statement, calling on governments to take immediate steps to appoint a Chief Nursing Officer. ICN President Annette Kennedy joined the consultation on Women’s Leadership and the UN Women Strategic Plan 20222025 in June and the ICN CEO spoke on gender and leadership at the Launch Event of the Policy Action Paper Closing the Leadership Gap: Gender Equity and Leadership in the Global Health and Care Workforce. He expressed ICN’s firm support to this Action Paper which explores the status of women in leadership in



the health and care sector and confirms that feasible policy interventions exist to ensure more gender-equitable and representative leadership. Gender equity took top billing at the ICN Congress in November 2021 during a panel session on Gender equality and empowering women: making life better for everyone. UN High Commissioner for Human Rights, Dr Michelle Bachelet, addressed participants along with Dr Roopa Dhatt, Executive Director and Co-Founder of Women in Global Health; Mariam Jalabi, Representatives of the Syrian Opposition Coalition to the United Nations and co-founder of the Syrian Women’s Political Movement; and Dr Nomafrench Mbombo, Western Cape Minister of Health, South Africa.

“Nurses continue to face many challenges: we know this is a highly gendered reality, with women the majority in the nursing workforce. And despite your importance to healthcare, nurses are frequently underpaid and disregarded, your views, needs and rights neglected. Empowering healthcare workers as human rights defenders can prevent human rights violations occurring in the care of patients, it also promotes and protects the rights of healthcare workers, reduces power asymmetries, contributes to decent working conditions and builds a climate of respect.” DR MICHELLE BACHELET, UN HIGH COMMISSIONER FOR HUMAN RIGHTS, SPEAKING AT THE ICN CONGRESS


the four countries presented their work, experiences and testimonials to raise awareness of the continuing need to support the girls of their deceased nursing colleagues by donating to the GCEF.

INTERNATIONAL NURSES DAY 2021 International Nurses Day (IND) is celebrated around the world every 12 May, the anniversary of Florence Nightingale’s birth. ICN commemorates this important day each year with the production and distribution of the IND resources and evidence. In February, ICN started its 100-day countdown to International Nurses’ Day which included the announcement of the winners of the first IND 2021 Photo Contest in four categories. The Grand Prize winner was Bruno Lavi from Israel, whose beautiful black and white photo of nurse Rawan Hijana dressed in her mask and shield, perfectly illustrated the reality of the pandemic. On 12 May, ICN launched the IND report, Nurses: A Voice to Lead – A Vision for Future Healthcare which called for nurses to be the architects and designers of future healthcare systems, and not only the deliverers of care. The report demonstrated the vital roles nurses play in successful healthcare services and argues for greater involvement of nurse leaders in all healthcare organisations and at all levels, including government. ICN also hosted a special webinar, attended by over 1,300 nurses from 73 countries. The ICN President took part in a high-level World Economic Forum panel addressing the topic of the critical role of healthcare workers during the COVID pandemic.

The ICN and Florence Nightingale International Foundation’s Girl Child Education Fund (GCEF) supports the primary and secondary schooling of girls under the age of 18 in developing countries whose nurse parent or parents have died. The GCEF has enabled over 400 orphaned girls in Kenya, Lesotho, Swaziland and Uganda to complete school. Many go on to become leaders in their communities, helping to strengthen and empower other girls; several have followed in their parents’ footsteps to become nurses. In 2021, 77 girls were supported by the Fund. In April, many of the girls whose schools had been closed due to the pandemic were able to return. Some of them were able to complement their learning remotely with the help of radio, television or smartphones, provided by the GCEF project. During the ICN Congress in November, a session was held in which the NNAs from







AWARDS In 2021, several ICN leaders received awards for their outstanding contributions to healthcare. ICN President Annette Kennedy received the prestigious Director General’s Health Leaders Award for Outstanding Leadership in Global Health from WHO Director General, Dr Tedros, at the ICN Congress in November, in recognition of her life-long contribution to the nursing profession. She also received an honorary doctorate from Dublin City University in recognition of her leadership of the global nursing workforce. First Vice President, Pamela Cipriano, was named number 2 on Healthcare Global’s list of the Top 10 Women in Healthcare for 2021. ICN CEO Howard Catton was made a Paul Harris Fellow by the Rotary Club International in recognition of his extraordinary service to the nursing community during the COVID-19 pandemic. Dr Michelle Acorn, ICN Chief Nurse, was inducted as a Fellow of the American Academy of Nursing. Dr Myrna Abi Abdallah Doumit, immediate past-President of the Order of Nurses in Lebanon, received the 2021 Women in Global Health’s Heroine of Health Award for her leadership of nurses in her country in the weeks and months after the terrible explosion in Beirut in August 2020, and throughout the COVID-19 pandemic. During the ICN Congress and the meeting of the Council of National Nursing Association Representatives, ICN presented certain awards that recognise outstanding achievement and encourage initiative and talent.


The Taiwan Nurses Association (TWNA) and the National Association of Nurses in El Salvador (ANES) received ICN Innovation Awards for their innovative and successful strategies to increase inclusiveness, diversity, and creativity for the NNA and/or for the nursing profession. The TWNA was given the award for its selection and financial support of participants on three nursing leadership programmes, the ICN Global Nursing Leadership Institute, the TWNA Nightingale Nursing Leadership Institute, and the ICN Leadership for Change Programme. The ANES received its award for implementing the Competencies and Skills through Specialisation and Certification of Nursing Professionals programme, an innovative and inclusive project in El Salvador.

The Kim Mo Im Policy Innovation and Impact Award was presented to Professor Abel Avelino de Paiva e Silva for his contributions to the development of the ontology reference model which is recognised as a reference for its policy of information systems and for the representation of formal knowledge involved in nursing care.

The Christiane Reimann Prize recognises outstanding nursing achievement and is known all over the world as nursing’s most prestigious international award. The award was given to Dr Sheuan Lee, an outstanding nurse leader, who served as President of the Taiwan Nurses Association and an ICN Board Member. In 2008, she was appointed as Minister without Portfolio in the Examination Yuan, which oversees the examination of civil servants.

The ICN and Florence Nightingale International Foundation’s International Achievement Award recognised two Austrian nurses, Marianne Stoeger and Margaret Pissar, for their lifelong devotion and sacrifice in treating patients with Hansen’s disease on Sorok Island, in South Korea.

ICN’s Health and Human Rights Award recognises truly significant humanitarian contributions and achievements in the domain of health and human rights. In 2021, the award was presented to Lord Nigel Crisp, the co-Chair of Nursing Now, who had the foresight from a very early stage to recognise the importance of healthcare as part of human rights.


The Partners in Development Award, which recognises foundations, corporations, NGOs or other groups that have demonstrated outstanding leadership and investment in nursing and healthcare capacity building, was given to CGFNS International for its strong support of ICN and for launching the Certified Global Nurse Consultants (CGNC) programme (see page 35).


NURSING STUDENTS The ICN Nursing Student Steering Group (NSSG) was created to support the work on student engagement at ICN and in global nursing policy. Represented by one student from each ICN region, the group’s main activities in 2021 included supporting the planning of the Student Assembly, participating in the World Health Assembly, working with NNAs in their regions to support student engagement, and providing direction for future student engagement at ICN. The ICN Nursing Student Assembly took place virtually on 23 October and brought together around 500 nursing students from around the world. The biennial Assembly is designed to provide a forum for nursing students and those in the early stages of their careers to have a voice and to contribute and influence the future of nursing through ICN. The Assembly is run by students for students, and this year had 20 student speakers from 18 countries in the programme. The meeting covered a wide range of topics of vital interest to nurses at the beginning of their careers, including how nursing students have coped during the COVID-19 pandemic, mental health issues and their role as leaders now and in the future.

STRENGTHENING AND PROTECTING THE NURSING WORKFORCE ADDRESSING NURSING WORKFORCE CHALLENGES In 2021, ICN produced reports and fact sheets on a variety of topics including: mass trauma experienced by the global nursing workforce; COVID-19 Infections and deaths among nurses and other healthcare workers; stress and burnout in the nursing profession; and the global nursing shortage and nurse retention. Following the 2020 publication of the ICN/CGFNS/ICNM policy brief Ageing Well? Policies to support older nurses at work, a webinar was held in May 2021 on the Ageing Nursing Workforce – From assessment to implementation: 10 steps to retain your nurses. Up to 4.7 million nurses worldwide are expecting to retire by 2030 and this policy brief builds on the WHO’s State of the World’s Nursing report by detailing the policy implications and strategies that must be adopted to retain older nurses in the workplace.

EDUCATION ICN published a fact sheet on nursing education and a policy brief on Nursing Education and the Emerging Nursing Workforce in the COVID-19 Pandemic, which reported on the results of the ICN survey of NNAs in December 2020 showing that 73% of NNAs reported that undergraduate nursing education had been disrupted and 54% reported disruption to postgraduate education. The brief also presented opportunities and challenges for the profession. In June, ICN, the World Bank, ECSACON and Jhpiego released a report on the Education and Labour Market for Nurses in the East, Central and Southern Africa (ECSA) Region, which reiterated the importance of investing in nursing education in the ECSA region to meet existing needs, highlighting the importance of information systems to make effective policy decisions. The launch was followed in July by an ICN-hosted webinar Nursing Education & Workforce – Implementing the Strategic Directions in the ECSA Region which looked at building collaboration with NNAs and Nursing Now Groups in the ECSA region to explore strategies to implement national and regional priorities on the WHO’s SDNM.





VIOLENCE Violence against healthcare workers is not a new phenomenon, but the COVID-19 pandemic has seemingly exacerbated the occurrence of violent events against health professionals and healthcare providers. In March, ICN, along with other members of the Steering Committee of the Safeguarding Health in Conflict Coalition (SHCC), co-hosted a webinar to discuss violence against healthcare workers, services and infrastructure during the COVID-19 pandemic. The Insecurity Insight interactive map was launched, depicting 1,172 reports of violence and threats against healthcare in 2020, of which 412 were directly related to the COVID-19 pandemic and response measures. ICN, a founding member of the SHCC, contributed significantly to this work. In May, the SHCC released its eighth annual report, documenting the global incidence of attacks and threats against health workers, facilities and transport around the world. The report, to which ICN contributed, cited 806 incidents of violence against or obstruction of healthcare in 43 countries and territories in ongoing wars and violent conflicts in 2020. ICN works closely with the International Committee of the Red Cross (ICRC) and other partner organisations on the Health Care in Danger (HCiD) Project to promote the protection of healthcare in armed conflict and other emergencies. As part of the committee of concern, ICN presented an overview of COVID-19 impact on nurses, and the reality of violence against health care from a nursing perspective in the Eurasia regional event in February 2021. The issue of violence against healthcare workers was highlighted in a partner symposium session, Renewing solidarity and empowering nurses in changing the reality of violence against healthcare, at the ICN Congress in November. The symposium brought together different actors, including the ICRC, MSF and SHCC, to address initiatives, engage nurses in the discussion, and highlight the unique voice, leadership and advocacy roles of nurses, especially how such voices can be amplified and empowered in promoting protection of healthcare from the community to the policymaker and national level.


“Health workers are being put at increased risk at a time when their communities need them more than ever. The fact that they fear violence and abuse while on the front lines carrying out essential work is completely unacceptable and is adding to the mass traumatisation that they are experiencing. Governments and all stakeholders must do their part and take immediate action to stop this violence. As with COVID-19 infection rates amongst health workers, it is essential that we have data on all threats and violence because without the data we cannot create effective strategies to prevent them.” HOWARD CATTON, ICN CEO

VACCINE EQUITY In January, ICN reiterated its calls for nurses to have early access to the COVID-19 vaccination. ICN also attended the expert meeting on Mobilizing Patient Groups to Change Vaccine Policy organised by the International Federation on Ageing to contribute to the discussion on how best to position the policy issues and strategies for action of low uptake rates of vaccination within at-risk populations. ICN highlighted the important role of nursing engagement in vaccination programmes. In February, ICN announced its support for WHO’s Vaccine Equity Declaration and warned that delay to global roll out of vaccines was potentially catastrophic. ICN announced that its latest survey of NNAs from 54 countries around the world highlighted a stark divide between high- and low-income countries and significant regional gaps in vaccination programmes which risked propagating the spread of new variants of the virus. The ICN CEO participated in a meeting on COVID-19 Vaccination and Equity organised by the World Federation of Public Health Associations to enable the exchange of knowledge and define potential joint advocacy activities for an equitable approach to COVID-19 immunisation and strengthen COVID-19 vaccine confidence. He also attended a consultative meeting on the European Immunization Agenda 2030 with a consortium of non-state actors in the WHO European Region. The meeting brought the opportunity to discuss how COVID-19 vaccination will set the stage for immunisation in the next decade and to exchange views and reflections on partnerships, good practices from field and lessons learned.


In March, ICN attended the ACT-A Vaccine Pillar Civil Society Dialogue, organised jointly by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations and WHO, to inform and involve civil society organisations and community representatives in aspects of the rollout of COVID-19 vaccines. In April, Howard Catton spoke at a webinar entitled Living up to COVID-19 vaccination challenges: perspective nursing, organised by the Department of Nursing at Ono Academic College, Israel, and, during an interview with Deutsche Welle television, he called on world leaders to “step up to the ethical plate on vaccine equity.” On 19 July, the BBC reported on ICN’s concerns about low vaccination rates among nurses and other healthcare workers. The story reported that nurses and other healthcare workers are being ‘left behind’ in efforts to vaccinate the world against COVID-19. ICN, working in collaboration with WHO, put the BBC in touch with NNAs around the world to provide information about the situation. In consequence, their stories were aired to many millions of BBC viewers, listeners and readers worldwide. Howard Catton was further interviewed by the BBC on 21 July about prioritising vaccinations for nurses and other healthcare workers. In September, ICN continued to warn that the slow roll-out of vaccines across Africa and other parts of the developing world was putting exhausted nurses and other health workers at risk. On a visit to Rwanda, Mr Catton met with the Rwandan Minister of Health Dr Daniel Ngamije, to discuss vaccine equity, amongst other topics. He also spoke to Newzroom Afrika about the consequences of inequality in vaccination rates in Africa. The ICN Congress in November featured a session exploring how nurses in the WHO European Region have been managing the COVID-19 vaccination roll out and how they can leverage their influence to build vaccine confidence among the population during the pandemic. ICN has published a separate report on its work in 2021 regarding the COVID-19 pandemic. Click here to read that report.






ICN has partnered with the World Continuing Education Alliance (WCEA) to bring professional development training resources in Leadership, Management, Advocacy and Teamwork, as well as free COVID-19 resources, to nurses everywhere. The online platform and mobile app are available free of charge to ICN member organisations in low- and middle-income countries.

In October, ICN announced a new partnership that will lead to stronger and more sustainable nursing associations on the African continent for improved healthcare delivery and health prevention measures: Organizational Development of National Nursing Associations (ODENNA). Supported by the Johnson & Johnson Foundation, this partnership aims to bring together ICN’s NNAs and Nursing Now groups in Africa with the goal of improving protection, support and advocacy for nurses on the ground. The scheme is a package which includes organisational assessment, the ICN’s LFC™ programme (see page 33), and twinning well-established NNAs with less mature associations to enable them to increase their capacity to represent their nurses, yielding mutually beneficial engagement and collaboration. Phase 1 of the ODENNA partnership (November 2021June 2022) will include securing participation of interested NNAs and the training of faculty and facilitators from NNAs who will eventually run educational activities in participating countries. Phase 2 will see the implementation of the ICN Organisational Assessment Tool and the development by NNAs of plans to address areas identified for improvement, and Phase 3 will involve the establishment of the LFC programme in each participating country.

ICN CODE OF ETHICS FOR NURSES On Global Ethics Day, 20 October, ICN launched its newly revised ICN Code of Ethics for Nurses, a statement of the ethical values, responsibilities and professional accountabilities of nurses that defines and guides ethical nursing practice within the different roles nurses assume. The 2021 revised edition has four principal elements that provide a framework for ethical conduct: nurses and patients or other people requiring care or services, nurses and practice, nurses and the profession, and nurses and global health. The Code also contains charts to assist nurses to translate the standards into action. The Code has served as the standard for nurses worldwide since it was first adopted in 1953.


In 2021, WCEA continued to work to increase their educational partners and improve their platform. The WCEA mobile app enabled front-line workers to access webinars, the first of which was held with WHO AFRO, UNICEF and UNFPA on the Introduction to the WHO Labour Care Guide. The app encouraged information sharing, creating effective and quick feedback channels which in turn provided greater insight into the training needs and experience of those on the frontline in these countries. In response to COVID-19 pandemic, WCEA announced a partnership with ICN, Johnson & Johnson and the Aga Khan University School of Nursing and Midwifery East Africa to support frontline health workers through the development of a focused training programme delivered via the app.


ADVOCACY AND LOBBYING As part of ICN’s mission to represent nursing worldwide, advance the nursing profession, promote the wellbeing of nurses, and advocate for health in all policies, ICN regularly lobbies governments at the request of its members. During the COVID-19 pandemic this work has become more frequent as nursing associations ask ICN to help them strengthen relations with their governments in order to protect the nursing profession. In January, at the request of the National Nurses Association of Kenya, Annette Kennedy wrote to His Excellency Uhuru Kenyatta, President of Kenya, asking for him to open dialogue with the NNA, nurses and other healthcare workers to resolve ongoing strikes and protests and to ensure that healthcare workers are protected physically, financially and psychologically. In March, at the request of the Lesotho Nurses Association, ICN wrote to the Prime Minister of Lesotho asking for nurses in the country to be reinstated after hundreds were sacked for taking strike action over pay, safety and decent conditions. In May, ICN called on the Government of Myanmar to respect the rights of nurses and other healthcare workers. Following the military coup in February, nurses and other healthcare workers in Myanmar had come under intense pressure, not only from the demands of treating the sick and injured, but also because the increase in violent incidents which put healthcare workers’ health and wellbeing in peril. In June, as US President Joe Biden and Russian President Vladimir Putin met in Geneva, ICN seized the opportunity to join Swiss nurses gathered in the city to remember the 115,000 or more health workers from around the world who have died because of the pandemic. ICN also backed Swiss nurses in their attempt to secure better pay, education and working conditions through a national referendum. The initiative, which passed on 28 November, called on the government and cantons to upscale the number of nurses being trained and to guarantee certain working conditions and salary rates in order to properly value the profession.

Starting in August, ICN held regular conversations with the Afghan Nurses Association and called on the international community to ensure that the respect and recognition of human rights, particularly of women and girls, are at the heart of the political discussions in Afghanistan. The Afghan Nurses Association asked the countries receiving Afghan nurses who had fled the conflict to support them and incorporate them into their health systems. They emphasised that the majority of nurses who remain in Afghanistan, especially female nurses, face concerns about whether they will receive salaries or even have jobs in the future.

ICN HUMANITARIAN FUND Even in the midst of a pandemic, natural disasters and man-made conflicts continue to cause deaths, injuries and devastation. ICN has expanded its Disaster Fund to cover other humanitarian crises. The Humanitarian Fund provides support to nurses and NNAs working in areas and times of disaster and conflict. In 2021, a number of disasters affected our NNAs, including the series of earthquakes in Sulawesi. Indonesia in January; a 7.2 magnitude earthquake in Haiti in August; the military coup in Myanmar; the political upheaval in Afghanistan; and the December Typhoon Rai in the Philippines. ICN contacted the NNAs in all these countries to offer our support and solidarity to the nurses. On World Humanitarian Day, ICN honoured healthcare and aid workers who continue to support people in conflicts and disasters across the world, pointing out the threat of climate change to human health, wellbeing and global development.





ICN GLOBAL NURSING LEADERSHIP INSTITUTETM The innovative and acclaimed ICN Global Nursing Leadership Institute (GNLI)™ is a strategic policy leadership programme focused on strengthening nurses’ political and policy understanding and influence. It is framed by nursing opportunities in a global movement committed to sustainable development and explores key themes that underpin the United Nations’ Sustainable Development Goals. In GNLI 2021, an emphasis on health disparities and the COVID-19 pandemic primed scholars to participate in local, regional, national and global policy discussions and actions. In 2020, GNLI moved on to a virtual platform, therefore Module Two of GNLI 2020 took place from January-March 2021 with 23 scholars from 21 countries. Scholars then prepared their individual and regional projects, which were presented to WHO Regional representatives and other stakeholders in June 2021. Two scholars were invited to be part of ICN’s delegation to the World Health Assembly. GNLI 2021 kicked off in September 2021 with 30 scholars from 19 countries. The GNLI Regional faculty met with scholars in their regions to begin the programme’s work to strengthen nurses’ political and policy understanding and influence, and prepare scholars to participate in local, regional, national and global policy discussions and actions. Later in the year, Regional Leads from the WHO’s Regional Offices joined scholars in their region to discuss the office’s priorities, building an important bridge between nurse leaders and WHO Regional Offices.

A network of GNLI Alumni has been formalised: a Steering Committee formed by regional representatives has been put in place through regional meetings. GNLI Alumni had a chance to reconnect during the ICN Congress in November, with dedicated sessions in which they shared personal and professional experiences post-GNLI and current work and projects.

LEADERSHIP FOR CHANGETM Established in 1995, the ICN LFC TM programme aims to prepare nurses with the leadership skills required to implement organisational change for the purpose of improving nursing practice and achieving better health outcomes. LFC programmes are tailored to respond to the specific needs of the countries in which they are implemented, through close collaboration with the NNAs. Based on the success of the current programmes and methodology, the LFC programmes build a stronger and more efficient workforce which, in turn, brings significant benefits to the populations they serve. ICN LFC programmes have been implemented in more than 70 countries. In 2021, LFC programmes were run in the Bahamas, Cambodia, China, India and Norway. In the Bahamas, a new LFC programme for a cohort of nine nurse leaders was concluded in January 2021. LFC Cambodia, sponsored by the Danish Nurses’ Organisation was launched in October 2021 and will conclude mid-2022. Senior nurse administrators who have completed the GNLI are serving as mentors and facilitators for the LFC Programme in their country. This illustrates a prime example of nurse leaders supporting cultivation of the next generation of nurse leaders!



2021 represented a significant milestone for LFC in China, supported by Johnson & Johnson. This initiative aims to enable the development of 400 senior level nurses with the leadership skills for the purpose of improving nursing practice and achieving better health outcomes in China. Following the early-stage pilot sessions and train the trainer sessions, the programme was rolled out more extensively in 2021, helping Chinese nurses to acquire a greater understanding of the global health challenges, obtain insights into international leadership styles, develop organisational changes through group projects, and improve the management capability in the context of health system redesign and transformation. Along with the training that is being run in different provinces of China, a strong cooperation has formed between the Chinese Nursing Association and the local nursing associations which will have a long-lasting impact for the nursing profession. Following delays caused by the COVID-19 pandemic, the LFC programme in India began in December 2021 with the training of 40 nurse leaders, divided in two cohorts. In January 2021, the Norwegian Nurses Organisation continued with the implementation of the LFC programme, adapting to delivery online. During the ICN Congress, a Symposium was held on Leadership Development in Action: ICN’s Leadership For Change and Global Nursing Leadership Institute Programmes. The GNLI and LFC Programme Directors presented the aims of each programme, approaches, outcomes and changes wrought by the pandemic. Former participants in each programme shared their experiences and the impact on themselves, nursing and health. The session concluded with a discussion on how these programmes might increase nursing leadership development in-country, regionally and globally.



ICN CERTIFIED GLOBAL NURSE CONSULTANT In February 2021, ICN and CGFNS International launched the first-ever certification programme to recognise nurses’ extraordinary capabilities and develop a cadre of Certified Global Nurse Consultants (CGNC). This new programme enables ICN to identify and certify a body of accomplished nurses who will form a powerful resource of specialists to address the increasing demand for expert nursing advice worldwide. Through the CGNC certification programme, CGFNS International and ICN will recognise the capabilities of nurses from around the world serving in a variety of roles, from specialised clinicians and policymakers to educators, administrators, and beyond.

ADVANCED PRACTICE NURSING During the COVID-19 pandemic, the role of Advanced Practice Nurses (APNs) has been critical to the care, treatment and very survival of patients. Globally, APNs are one of the fastest growing health professions. They are essential for innovating healthcare systems to improve access to care, achieve better health for people, and to reduce healthcare costs.

APN PUBLICATIONS In 2021, as part of its series of guidelines on Advanced Practice Nursing, ICN launched two new reports. The Guidelines for Nurse Anesthetists supported the WHA 2015 resolution, WHA68.15, to “strengthen emergency and essential surgical care and anesthesia as a component of universal health coverage” and to ensure that, by 2030, five billion people will be able to access safe and affordable surgical and anesthesia care around the world. Countries which have adopted the resolution can use these guidelines to strengthen the role of Nurse Anesthetists with the aim to provide safe and affordable anesthetic care to their populations.

The new Guidelines on Prescriptive Authority for Nurses aimed to facilitate a common understanding of nurse prescribing to inform policymakers, educators, regulators, healthcare planners, nurses, and other healthcare professionals. It emphasised that critical elements are needed to support the development and enhancement of nurse prescribing and called for governments to ensure appropriate education for nurses, aligned regulatory authority and continuing professional development to uphold competencies. ICN, in partnership with Springer, has produced a series of Advanced Practice Nursing books, which are offered to ICN members at a 20% discount. In 2021, two books in the series were launched: Clinical Nurse Specialist Role and Practice, which featured an in-depth examination of advanced speciality practice in nursing, and the advanced practice role of the clinical CNS; and Spiritual Dimensions of Advanced Practice Nursing.

ICN NURSE PRACTITIONER/ADVANCED PRACTICE NURSING NETWORK In August, the ICN NP/APN Network held its 11th conference with over 1,000 advanced practice nurses from 48 countries in attendance. Canadian Premier Justin Trudeau spoke at the opening ceremony of the virtual conference which had the theme Envisioning Advanced Practice Nursing Beyond 2020: Wider Reach, Bigger Impact. The ICN NP/APN Network undertook a second large international study to understand how the emotional and spiritual wellbeing and resilience of Advanced Practice Nurses during COVID has been impacted to date. The study is part of the work of the ICN NP/APN Network’s Global Academy of Research and Enterprise which focuses on research and enterprise that inform and facilitate the ongoing development of APN.







ICN CONGRESS ICN holds an international gathering of nurses every two years, hosted by one of our members associations. These Congresses enable us to offer the latest information on a rich array of subjects and feature inspiring plenary speakers. They are a fantastic opportunity for nurses to build relationships and to disseminate nursing knowledge and leadership across specialities, cultures and countries. The 28 th ICN Congress was planned to be held in 2021 in Abu Dhabi, United Arab Emirates. Due to the COVID-19 pandemic, the Congress was, instead, held virtually for the first time. Over 5,500 participants from 132 countries gathered over four days to hear from expert speakers including present and former world leaders, such as Helen Clark, former Prime Minister of New Zealand and Chair of the Independent Panel for Pandemic Preparedness and Response; Ban Ki-moon, former Director General of the United Nations; Dr Michelle Bachelet, High Commissioner for Human Rights and former President of Chile; and Gordon Brown, former UK Prime Minister.

“Despite the current challenges that we face, if we work together under the spirit of partnership, innovation, sustainability and the commitment to expanding and delivering healthcare of all, we will not only persevere during this era of uncertainty, we will thrive… Together we can end this terrible pandemic which has significantly impacted each and every nurse around the world and has tragically taken the lives of 115 000 healthcare workers.” BAN KI-MOON, FORMER UN GENERAL SECRETARY AT THE ICN CONGRESS

Expert speakers in the field of health included Dr Tedros Adhanom Ghebreyesus, WHO Director General; Dr Maria Van Kerkhove, WHO COVID-19 Technical Lead; Dr John-Arne Røttingen, Ambassador for Global Health at the Ministry of Foreign Affairs, Norway; Her Royal Highness Princess Muna al Hussein; and Dr Roopa Dhatt, Executive Director of Women in Global Health. Nurses at the highest levels of leadership also spoke at the Congress, including Annette Kennedy, ICN President; Lauren Underwood, U.S. Congresswoman; Peggy Vidot, Minister of Health, Seychelles; and Dr Nomafrench Mbombo, Minister of Health, Western Cape, South Africa. Other prestigious speakers included Mr Guy Ryder, Director General of the International Labour Organization; Mariam Jalabi, Representative of the Syrian Opposition Coalition to the United Nations; and Jeremy Hunt, British Member of Parliament and Chair of the Health and Social Care Select Committee. Celebrities from across the globe sent in messages of support, including tennis champion Roger Federer; global media leader and philanthropist, Oprah Winfrey; religious leader Pope Francis; musicians Bono



and Carla Cruells Perez and K-pop idol band SHINee; Australian Prime Minister Scott Morrison; and artist Philip Stanton. The Congress theme, “Nursing Around the World” was reflected in the regional sessions which were held each day, highlighting issues and challenges in the six ICN regions: Eastern Mediterranean, Europe, Africa, Americas, Western Pacific, and Southeast Asia. Sessions covered a variety of topics including the COVID-19 pandemic; global health security, emergency and disaster preparedness; technology; mental health; investing in nursing; nursing regulation; strengthening health systems; patient safety; nursing in the mass media; nursing education; healthy ageing; nursing leadership; gender equality; non-communicable diseases; human rights and the rights of health workers; the nursing workforce shortage; digital health data; the health and wellbeing of nurses; and the WHO SDNM.

INTERNATIONAL CLASSIFICATION FOR NURSING PRACTICE® The International Classification for Nursing Practice (ICNP®) provides an international standard to facilitate the description and comparison of nursing practice locally, regionally, nationally and internationally. Since its introduction in 1999, ICNP has been translated into 19 languages, and there are currently 14 research and development centres worldwide running more than 200 different projects. New versions of ICNP are released every two years. ICN has been working with SNOMED International to integrate ICNP into SNOMED CT, the most comprehensive clinical terminology in use around the world and the ICNP SNOMED CT Nursing Practice Refset was released in October 2021. The integration of ICNP enhances nursing content within SNOMED CT while facilitating shared record keeping and patient-centred care across a broader user base. ICNP experts participate actively in the SNOMED International Nursing Clinical Reference Group, which oversees nursing content within SNOMED CT. In order to ensure good governance, ICN established the ICNP Editorial Board in April 2021, comprising representatives from each of the ICN-accredited ICNP Research & Development Centres and ICN Board liaison. The Editorial Board assures the quality of ICNP and ensure relevance and usefulness for nurses worldwide. The ICNP 2021 version can be accessed here.


MEDIA AND SOCIAL MEDIA Both 2020 and 2021 were unusual years for ICN as for everyone. So many of our traditional ways of sharing, collaborating and getting together were cancelled. However, social media did allow us the opportunity to dialogue with our members, affiliates, partners and the public. Over the year, ICN gained over 4,500 new followers on Twitter, almost 5,000 new followers on Facebook and we almost doubled the number of followers on LinkedIn. We added 24 new videos on our YouTube channel ranging from webinar recordings to messages to our members, to statements at the World Health Assembly and other international meetings. The ICN Chief Nurse launched a monthly blog on the ICN website to showcase ICN’s nursing and project work.

BBC PARTNERSHIP In May 2021 ICN and BBC StoryWorks announced a 12-month campaign to produce a series of video films in conjunction with ICN’s NNAs. The films will be showcased on a dedicated BBC hub on its website and shine a light on the global nursing workforce. The ground-breaking series will educate and inform the public about the profession by providing a unique and intimate portrait of the world of nursing. An introductory video was played at the ICN Congress, showcasing stories of nurses.

PUBLICATIONS ICN publications produced in 2021 have been mentioned throughout this report. All publications can be found on the ICN website. ICN’s official journal, The International Nursing Review, is a quarterly, peer-reviewed journal that focuses predominantly on nursing and health policy issues of relevance to nurses and has an increasing impact factor. In July, Professor Parveen Ali was appointed the new Editor-in-Chief of the journal. Dr Ali, a registered nurse and midwife, has a distinguished career as a professor of nursing at the University of Sheffield, and is the recipient of various awards. She succeeded Professor Sue Turale, who had edited the journal since May 2013.

FINANCIAL OVERVIEW 2021 INTERNAL CONTROL SYSTEMS & AUDITS ICN’s financial statements are annually audited by independent external auditors, KPMG. Additionally, ICN has an Audit and Risk Committee dedicated to providing the Board oversight of the effectiveness of the organisation’s risk management, internal control and compliance system. This independent and impartial committee, regularly reports on their work to the Board, CNR and Member associations.

OPERATIONAL EXPENDITURES The 2021 annual operational budget was dedicated to: • 65% to support our Members and global nursing through Nursing Policy, Programmes and Communication & Events • 13% to Executive and Governance strengthening, supporting and connecting our member associations • 22% general and administration supporting the core mission of ICN

The year 2021 was marked by a focus on strengthening the internal control environment and implementing a new operational plan.

9% 22%

FINANCIAL OVERVIEW The information presented is extracted from audited financial statements. The figures presented are in Swiss Francs (CHF). KCHF and MCHF respectively stand for thousands and millions CHF. The ICN financial position continues to be healthy and stable with total assets of 12.4 MCHF. The designated and general funds of the organisation amount to 9.4 MCHF. The year 2021 was marked by continuing strong advocacy and communication activities on the devastating effects of the pandemic on nurses and midwives as well as the successful virtual Congress and CNR. The operational profit of 2021 amounts to 181 KCHF, including the net profit of 232 KCHF of the Congress. The net result is a gain of 355 KCHF in 2021. It should be noted that the ICN Congress is held every two years, consequently both operational income and expenditure of Congress years are higher than the previous year.

REVENUES ICN’s activities are mainly funded by membership fees representing 80% of ordinary operational income in 2021 - excluding the Congress income. Including Congress income, membership dues amounted for 67% of the 6,6 M CHF total net operational revenue for 2021 (versus 84% in 2020). In 2021, the increase in operational income was driven by the 1.1 MCHF revenue of the Congress and 0.5 MCHF additional funds received for ICN Leadership and Organisational development programmes.





Nursing activities Nursing Communication & Events Programmes Executive & Governance General & Administration

The operational expenditures of the year are mainly impact by the following projects: As for the income, the evolution of the operational expenses of the year are driven by 0.9 MCHF Congress expenses. In 2021, the ICN programmes have grown - specifically on Leadership and Organisational development initiatives - and their increased implementation has resulted in additional income and expenditure compared to 2020. The Council of National Nursing Association representatives (CNR) was held virtually in 2021, at a cost of 0.2 MCHF.

RESULT FROM FINANCIAL ACTIVITIES The financial result of the year is a profit of 174 K CHF, driven by gain on investments and exchange currency impacts.








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